The purpose of this project is to determine the incidence rates, rates of progression, and risk factors for the chronic complications of type 2 diabetes. The study is conducted in the Pima Indians of the Gila River Indian Community, who have participated in a longitudinal epidemiologic study since 1965 (see project Z01 DK 69000). Risk factors for the major complications of diabetes, retinopathy, nephropathy, and coronary artery disease, are determined by longitudinal follow-up of diabetic subjects. Methods of ascertainment of these complications include fundus photography, measurement of urine albumin and serum creatinine concentrations, and electrocardiography. The incidence of diabetic nephropathy, as a function of duration of diabetes, was unrelated to age of onset of diabetes. Thus, risk of this complication is much more strongly related to characteristics of diabetes rather than age per se. The group is taking part in a multicentered genetic linkage study (Family Investigation of Nephropathy and Diabetes) of diabetic nephropathy in an attempt to identify susceptibility genes for nephropathy.